Heart Health News

Depression May Raise Low Blood Sugar Risk in Diabetics

TUESDAY, May 21 (HealthDay News) -- Depression can affect almost
every aspect of life, but some of the changes brought about by the
disorder can be downright dangerous for those with diabetes.

New research has found that people with diabetes who are
depressed have more than a 40 percent higher risk of having a
severe low blood sugar (hypoglycemia) episode that lands them in
the hospital compared to people with diabetes who aren't
depressed.

"Depression is a very common accompanying condition for people with diabetes. It's important to know that depression can lead to hypoglycemic episodes," said study author Dr. Wayne Katon, a professor of psychiatry at the University of Washington Medical School in Seattle.

"About one-quarter of all severe drug side effects that lead people to an ER visit or hospitalization are related to dramatic drops in blood sugar. Hypoglycemia is a dangerous and expensive problem. And, for people with diabetes, depression increases the risk of serious hypoglycemia by about 40 percent over five years, and leads to a greater number of hypoglycemic episodes," he explained.

Results of the study are published in the May/June issue of the
Annals of Family Medicine.

People with diabetes generally take medication that helps lower
their blood sugar levels. These medications can be pills, or in the
case of the hormone insulin, injections. However, sometimes these
medications work too well, and they drop blood sugar levels too
low. It's the glucose (sugar) in the blood that fuels the body and
the brain. Without enough glucose, the body and brain can't work
properly. If blood sugar levels drop too low, people can pass out.
If the hypoglycemic episode is severe enough, people can even
die.

So, someone living with diabetes has to maintain a balance
between the medications they take to lower their blood sugar and
what they eat. Other factors, such as physical activity and stress,
also can affect blood sugar levels.

The study included just over 4,100 people with diabetes. Nearly
500 of these people met the criteria for having major depression
during the five-year study period.

The average age of the study volunteers was 63, and the average
duration of diabetes was 10 years. Most -- 96 percent -- had type 2
diabetes. About one-third were taking insulin to control their
diabetes. Just 1.4 percent were experiencing complications of
diabetes.

In the five years before the study began, 8 percent of those
with both depression and diabetes reported having had a severe
hypoglycemic episode compared to 3 percent of the non-depressed
people with diabetes. During the five-year study, nearly 11 percent
of the depressed people with diabetes had a severe hypoglycemic
episode compared to just over 6 percent of the non-depressed people
with diabetes.

The risk of hypoglycemia was unaffected by the type of treatment
received. People taking oral medications were just as likely to
have a hypoglycemic episode as those taking insulin, according to
the study.

Overall, people with diabetes who were depressed had a 42
percent greater risk of having a severe hypoglycemic episode, and a
34 percent higher risk of having a greater number of hypoglycemic
episodes.

Katon said there are two likely explanations for these increased
risks. One is that depression leads to psychobiological changes
that cause big fluctuations in blood sugar levels, which may make
it harder to prevent low blood sugar levels.

The other possibility is that depression leads to a lack of
interest in the self-care that's necessary to manage diabetes well.
"People who are depressed may be less likely to test their blood
sugar levels regularly. They may adhere to their medications less
well. They may forget if they've taken them, and then end up taking
an additional dose," said Katon.

Another expert, Eliot LeBow, a therapist with a diabetes-focused
practice in New York City, and a type 1 diabetic himself, agreed
that "depression can affect a person's ability to manage their
diabetes." But, he said there was an important piece of information
missing from the study: how much diabetes education a person has
had. People who've had more diabetes education would probably be
less likely to have a severe hypoglycemic episode, LeBow
suggested.

He also noted that high blood sugar symptoms can look a lot like
depression symptoms. "Sometimes, when you make a few changes in how
someone is managing their diabetes, their depression may lift,"
said LeBow.

Both experts agree that people with diabetes who are depressed
need to get help. And, fortunately, there are treatments available
-- psychotherapy and medications. Katon said there are depression
medications that don't significantly affect blood sugar levels.

According to the U.S. National Institute of Mental Health,
depression symptoms include:

Long-term sadness, anxiety or hopelessness.

Feelings of guilt and worthlessness.

A loss of interest in activities you once enjoyed.

Sleep and appetite changes.

Trouble remembering things.

Difficulty concentrating or making decisions.

Suicidal thoughts.

Although the study found an association between depression and
greater risk of hypoglycemic episodes, it did not prove a
cause-and-effect relationship.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.